Question

what can you conclude about HMO's and PPO health insurance policies and practicies?

Answer 1

A Health Maintenance Organization is a kind of health insurance that needs each participant to select a PCP(Primary Care Physician). The PCP is responsible for referring you to the other network specialists or hospital instiutions whichever necessary.

There are primarly two types of Health Maintenance Organizations.The first type is the staff model or group practice plan. In the staff model, physicians are paid a standard salary regardless of the number of patients they see. Under this model it’s reasoned there are no incentives to give unnecessary service. Consequently, the organization should incur fewer costs thereby patients’ premiums can be held down.

Another type is the individual practice association. Under these plans, physicians earn a fee based on services provided or a fee for every HMO patient, regardless of whether any patient is seen. Because care is usually decentralized, both you and your doctor have to locate different medical facilities as they’re needed.

A Preferred Provider Organization is the other type of health insurance which offers a network of healthcare providers, but the difference is that PPO plans to give participants the freedom to choose care from any in- or out-of-network provider.

The biggest advantage that PPO plans offer over HMO plans is flexibility and versatility. PPOs offer participants much more choice or preference for choosing which and when they seek health care. Its disadvantage is that it is costly.

PPO plans generally come with a higher monthly premium than HMOs. So, unless you’re a person who sees a lot of specialists, a PPO plan could cost you more money over the course of a year.